| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
673 |
606 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
357 |
318 |
$24K |
| 92015 |
Determination of refractive state |
722 |
652 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
78 |
66 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
48 |
37 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
142 |
108 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
122 |
122 |
$1K |
| V2020 |
Frames, purchases |
14 |
13 |
$710.75 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
144 |
133 |
$641.92 |
| V2756 |
Eye glass case |
139 |
139 |
$231.78 |
| V2025 |
Deluxe frame |
117 |
116 |
$0.00 |